Propelus has unveiled its latest tool aimed at helping healthcare providers and organizations stay compliant and avoid costly legal pitfalls. The new Exclusions Monitoring API is designed to help healthcare entities screen for individuals and organizations that have been barred from participating in federal and state healthcare programs due to fraud, waste, or abuse.
Healthcare fraud is a massive problem, with the Department of Justice estimating losses of up to $100 billion each year. Individuals or entities involved in fraudulent activities are added to exclusion lists, which prohibit them from receiving payments from federal healthcare programs. Healthcare providers that unknowingly engage with excluded parties risk facing severe legal penalties, fines, and damage to their reputation.
Julie Walker, CEO of Propelus, emphasized the importance of vigilance in the healthcare sector, noting that organizations are responsible for ensuring they do not work with or pay excluded individuals or entities. “Our Exclusions Monitoring API provides the necessary tools for healthcare organizations to stay compliant with federal regulations, ensuring they have access to real-time exclusion data,” said Walker.
The Exclusions Monitoring API works in tandem with Propelus’s Primary Source Verification API, offering comprehensive monitoring services. It enables healthcare organizations to submit bulk data for screening, matching, and verification against exclusion lists from federal and state sources. The API performs monthly checks against primary sources, helping organizations maintain up-to-date compliance.
Among the lists monitored by the API are the Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities, the General Services Administration’s System for Award Management database, and 45 state Medicaid exclusion lists.
The launch of this new API is part of Propelus’s ongoing effort to support healthcare organizations in their fight against fraud and abuse, while also ensuring they remain compliant with regulatory standards.